Abstract:
BACKGROUND:Hematoma expansion (HE) occurs in approximately one-third of patients with intracerebral hemorrhage (ICH) and is known to be a strong predictor of neurological deterioration as well as poor functional outcome. This study aims to externally validate three risk prediction models of HE (PREDICT, 9-point, and BRAIN scores) in an Asian population. METHODS:A prospective cohort of 123 spontaneous ICH patients admitted to a tertiary hospital (certified stroke center) in Singapore was recruited. Logistic recalibrations were performed to obtain updated calibration slopes and intercepts for all models. The discrimination (c-statistic), calibration (Hosmer-Lemeshow test, le Cessie-van Houwelingen-Copas-Hosmer test, Akaike information criterion), overall performance (Brier score, R2), and clinical usefulness (decision curve analysis) of the risk prediction models were examined. RESULTS:Overall, the recalibrated PREDICT performed best among the three models in our study cohort based on the novel matrix comprising of Akaike information criterion and c-statistic. The PREDICT model had the highest R2 (0.26) and lowest Brier score (0.14). Decision curve analyses showed that recalibrated PREDICT was more clinically useful than 9-point and BRAIN models over the greatest range of threshold probabilities. The two scores (PREDICT and 9-point) which incorporated computed tomography (CT) angiography spot sign outperformed the one without (BRAIN). CONCLUSIONS:To our knowledge, this is the first study to validate HE scores, namely PREDICT, 9-Point and BRAIN, in a multi-ethnic Asian ICH patient population. The PREDICT score was the best performing model in our study cohort, based on the performance metrics employed in this study. Our findings also showed support for CT angiography spot sign as a predictor of outcome after ICH. Although the models assessed are sufficient for risk stratification, the discrimination and calibration are at best moderate and could be improved.
journal_name
Neurocrit Carejournal_title
Neurocritical careauthors
Lim JX,Han JX,See AAQ,Lew VH,Chock WT,Ban VF,Pothiawala S,Lim WEH,McAdory LE,James ML,King NKKdoi
10.1007/s12028-018-0631-8subject
Has Abstractpub_date
2019-04-01 00:00:00pages
394-404issue
2eissn
1541-6933issn
1556-0961pii
10.1007/s12028-018-0631-8journal_volume
30pub_type
杂志文章abstract:BACKGROUND:Terson's syndrome is intraocular hemorrhage (IOH) subsequent to subarachnoid hemorrhage (SAH). Its presence is associated with higher mortality in SAH. We report a case of Terson's syndrome and review the literature. CASE REPORT:A 71-year-old Caucasian gentleman collapsed and became comatose. Past medical h...
journal_title:Neurocritical care
pub_type: 杂志文章,评审
doi:10.1007/s12028-011-9555-2
更新日期:2011-12-01 00:00:00
abstract:INTRODUCTION:Patients on neurological intensive care units (NICU) who require ventilatory support often suffer from co-existing bulbar dysfunction, either because of their underlying disease or because of their decreased level of consciousness. For this reason, most patients are ventilated through a cuffed tracheostomy...
journal_title:Neurocritical care
pub_type: 临床试验,杂志文章
doi:10.1007/s12028-007-0024-x
更新日期:2007-01-01 00:00:00
abstract:INTRODUCTION:Delayed ischemic neurologic deficits secondary to vasospasm are a major cause of morbidity and mortality after subarachnoid hemorrhage (SAH). Treatment of vasospasm after SAH is associated with complications, and reliable techniques for evaluating effects of treatment of vasospasm in such patients are warr...
journal_title:Neurocritical care
pub_type: 杂志文章
doi:10.1385/ncc:6:1:40
更新日期:2007-01-01 00:00:00
abstract:BACKGROUND:To date, common therapy in patients with intracranial hemorrhage (ICH) includes prophylaxis of seizure using antiepileptic drugs, commonly phenytoin. Phenytoin therapy is associated with a high incidence of cognitive disturbance. Levetiracetam is known to cause less cognitive disruption and may be a suitable...
journal_title:Neurocritical care
pub_type: 杂志文章
doi:10.1007/s12028-010-9341-6
更新日期:2011-08-01 00:00:00
abstract:BACKGROUND:Diagnosis of intensive care unit acquired weakness (ICUAW) is challenging. Pathogenesis of underlying critical illness polyneuromyopathy (CIPNM) remains incompletely understood. This exploratory study investigated whether longitudinal neuromuscular ultrasound examinations and cytokine analyses in correlation...
journal_title:Neurocritical care
pub_type: 杂志文章
doi:10.1007/s12028-020-01148-2
更新日期:2020-11-24 00:00:00
abstract::A growing body of clinical literature emphasizes the impact of cerebral edema in early brain injury following aneurysmal subarachnoid hemorrhage (aSAH). Aneurysm rupture itself initiates global cerebral edema in up to two thirds of cases. Although cerebral edema is not a universal feature of aSAH, it portends a poor c...
journal_title:Neurocritical care
pub_type: 杂志文章,评审
doi:10.1007/s12028-016-0354-7
更新日期:2017-04-01 00:00:00
abstract:OBJECTIVE:To summarize trends in status epilepticus (SE) in the United States by age, race, sex, admission source, disposition, incidence rates, and mortality. METHODS:Data from US National Hospital Discharge Survey were used from 1979 to 2010 to identify discharges with SE and common etiologies and complications of S...
journal_title:Neurocritical care
pub_type: 杂志文章
doi:10.1007/s12028-013-9935-x
更新日期:2014-06-01 00:00:00
abstract:BACKGROUND:During late pregnancy and the puerperium cerebral venous and sinus thrombosis (CVST) is a rare but important cause of stroke. Despite adequate anticoagulation some patients deteriorate, which may warrant the use of more aggressive treatment modalities. CASE REPORT:A 29-year-old pregnant woman (29th week of ...
journal_title:Neurocritical care
pub_type: 杂志文章
doi:10.1007/s12028-010-9389-3
更新日期:2011-08-01 00:00:00
abstract:INTRODUCTION:Effective treatment for severe ischemic stroke continues to be largely an unmet medical need. Using a nonvascular (paravascular cerebrospinal fluid) pathway to provide oxygen and nutrients to ischemic tissues may be a means of treating this disease. The primary objective of this study was to evaluate the s...
journal_title:Neurocritical care
pub_type: 杂志文章
doi:10.1385/NCC:5:1:21
更新日期:2006-01-01 00:00:00
abstract:BACKGROUND:Impaired cerebrovascular reactivity (CR) has been reported to be associated with adverse outcome in patients with aneurysmal subarachnoid hemorrhage (aSAH). However, CR may be determined using different paradigms and it is unclear, which measurement method most suitable reflects the clinical course or is abl...
journal_title:Neurocritical care
pub_type: 杂志文章,评审
doi:10.1007/s12028-009-9287-8
更新日期:2010-04-01 00:00:00
abstract:BACKGROUND:Cerebral edema and raised intracranial pressure are common problems in neurological intensive care. Osmotherapy, typically using mannitol or hypertonic saline (HTS), has become one of the first-line interventions. However, the literature on the use of these agents is heterogeneous and lacking in class I stud...
journal_title:Neurocritical care
pub_type: 杂志文章
doi:10.1007/s12028-010-9477-4
更新日期:2011-04-01 00:00:00
abstract:BACKGROUND:Infection in the intensive care unit (ICU) empirically requires broad-spectrum antibiotics. Imipenem/cilastatin, often reserved for more serious hospital-acquired infections, is thought to be associated with a higher risk of seizures than other penicillins and carbapenems. We sought to evaluate the safety of...
journal_title:Neurocritical care
pub_type: 杂志文章,评审
doi:10.1007/s12028-008-9170-z
更新日期:2009-01-01 00:00:00
abstract:BACKGROUND:Release of cardiac biomarkers is reported in patients with subarachnoid hemorrhage (SAH). Data addressing the impact of cardiac injury on outcome in these patients is sparse. This study was conducted to ascertain the association of elevation of serum cardiac Troponin-I (cTnI) with mortality and neurological ...
journal_title:Neurocritical care
pub_type: 杂志文章
doi:10.1007/s12028-007-9038-7
更新日期:2008-01-01 00:00:00
abstract:OBJECTIVE:Stroke due to occlusion of the artery of Percheron (AOP), an uncommon anatomic variant supplying the bilateral medial thalami, may raise diagnostic challenges and cause life-threatening symptoms. Our objective here was to detail the features and outcomes in three patients who required intensive care unit (ICU...
journal_title:Neurocritical care
pub_type: 杂志文章,评审
doi:10.1007/s12028-014-9962-2
更新日期:2014-06-01 00:00:00
abstract:BACKGROUND:Neurogenic pulmonary edema (NPE) is an acute life-threatening complication associated with many forms of central nervous system injury. NPE usually appears within minutes to hours after injury and has a high mortality rate if not recognized and treated appropriately. Lung ultrasound quickly provides at the b...
journal_title:Neurocritical care
pub_type: 杂志文章
doi:10.1007/s12028-013-9828-z
更新日期:2013-06-01 00:00:00
abstract:BACKGROUND:Ischemic stroke and intracranial hemorrhage (ICH) following left ventricular assist device (LVAD) placement are major causes of morbidity. The incidence and mortality associated with these events stratified by device type have not been systematically explored. METHODS:A systematic review of PubMed was condu...
journal_title:Neurocritical care
pub_type: 杂志文章,评审
doi:10.1007/s12028-017-0386-7
更新日期:2017-08-01 00:00:00
abstract:BACKGROUND:Improvements in technology play an important role in caring for critically ill patients. One example is the advance in ventilator design to facilitate triggering of mechanical breaths. Minimal changes in circuit flow unrelated to respiratory effort can trigger a ventilator breath and may mislead caregivers i...
journal_title:Neurocritical care
pub_type: 杂志文章
doi:10.1007/s12028-010-9491-6
更新日期:2011-04-01 00:00:00
abstract:OBJECTIVE:To determine the clinical characteristics and outcomes of patients with neurogenic stress cardiomyopathy (NSC) among patients admitted to our neuroscience intensive care unit (NICU). METHODS:Following institutional review board approval, consecutive adult patients admitted to the NICU between 2009 and 2013 w...
journal_title:Neurocritical care
pub_type: 杂志文章
doi:10.1007/s12028-017-0412-9
更新日期:2017-12-01 00:00:00
abstract:BACKGROUND:Fever is associated with worse outcome after intracerebral hemorrhage (ICH). Autonomic dysfunction, commonly seen after brain injury, results in reduced heart rate variability (HRV). We sought to investigate whether HRV was associated with the development of fever in patients with ICH. METHODS:We prospectiv...
journal_title:Neurocritical care
pub_type: 杂志文章
doi:10.1007/s12028-019-00684-w
更新日期:2019-04-01 00:00:00
abstract:: ...
journal_title:Neurocritical care
pub_type: 评论,信件
doi:10.1007/s12028-018-0664-z
更新日期:2019-04-01 00:00:00
abstract:BACKGROUND:The initial noncontrast computed tomography (CT) study of the head after an aneurysmal subarachnoid hemorrhage (SAH) is used to predict the risk of developing vasospasm. Changes in the extent of subarachnoid blood seen on CT images occur as a function of time after SAH, but there is no consensus on the time ...
journal_title:Neurocritical care
pub_type: 杂志文章
doi:10.1007/s12028-009-9227-7
更新日期:2009-01-01 00:00:00
abstract:BACKGROUND:The objective was to investigate the impact of targeting tight glycemic control (4.4-6.1 mM) on endogenous ketogenesis in severely head-injured adults. METHODS:The data were prospectively collected during a randomized, within-patient crossover study comparing tight to loose glycemic control, defined as 6.7-...
journal_title:Neurocritical care
pub_type: 杂志文章,随机对照试验
doi:10.1007/s12028-016-0313-3
更新日期:2017-04-01 00:00:00
abstract:BACKGROUND:Fever control plays a key role in therapy of patients with acute brain injury. The infusion of cold saline could serve as an alternative or additional method for targeted temperature management. However, it is difficult to estimate the amount of fluid required to achieve normothermia merely on the basis of b...
journal_title:Neurocritical care
pub_type: 杂志文章
doi:10.1007/s12028-018-0588-7
更新日期:2019-02-01 00:00:00
abstract:BACKGROUND:Acute hydrocephalus is a common complication of aneurysmal subarachnoid hemorrhage (aSAH); however, attempts to predict shunt-dependent chronic hydrocephalus using clinical parameters have been equivocal. METHODS:Cohort study of aSAH is treated with external ventricular drainage (EVD) placement at our insti...
journal_title:Neurocritical care
pub_type: 杂志文章
doi:10.1007/s12028-019-00886-2
更新日期:2020-08-01 00:00:00
abstract:BACKGROUND:This prospective consecutive double-blinded randomized study investigated the effect of prostacyclin on pressure reactivity (PR) in severe traumatic brain injured patients. Other aims were to describe PR over time and its relation to outcome. METHODS:Blunt head trauma patients, Glasgow coma scale ≤8, age 15...
journal_title:Neurocritical care
pub_type: 杂志文章,随机对照试验
doi:10.1007/s12028-014-0030-8
更新日期:2015-02-01 00:00:00
abstract:BACKGROUND:Little data exist regarding the practice of sodium management in acute neurologically injured patients. This study describes the practice variations, thresholds for treatment, and effectiveness of treatment in this population. METHODS:This retrospective, multicenter, observational study identified 400 ICU p...
journal_title:Neurocritical care
pub_type: 杂志文章,多中心研究
doi:10.1007/s12028-016-0343-x
更新日期:2017-10-01 00:00:00
abstract::Amantadine and modafinil are neurostimulants that may improve cognitive and functional recovery post-stroke, but the existing study results vary, and no comprehensive review has been published. This systematic review describes amantadine and modafinil administration practices post-stroke, evaluates timing and impact o...
journal_title:Neurocritical care
pub_type: 杂志文章,评审
doi:10.1007/s12028-020-00977-5
更新日期:2020-08-01 00:00:00
abstract:BACKGROUND:Brain tissue hypoxia (PbtO2 < 20 mmHg) is common after subarachnoid hemorrhage (SAH) and associated with poor outcome. Recent data suggest that brain oxygen optimization is feasible and reduces the time spent with PbtO2 < 20 mmHg from 45 to 16% in patients with severe traumatic brain injury. Here, we intende...
journal_title:Neurocritical care
pub_type: 杂志文章
doi:10.1007/s12028-019-00753-0
更新日期:2019-10-01 00:00:00
abstract::Stroke in pregnant women has a mortality rate of 1.4 deaths per 100,000 deliveries. Vascular malformations are the most common cause of hemorrhagic stroke in this population; preeclampsia and other risk factors have been identified. However, nearly a quarter of strokes have an undeterminable cause. Spontaneous intracr...
journal_title:Neurocritical care
pub_type: 杂志文章
doi:10.1007/s12028-018-0501-4
更新日期:2019-02-01 00:00:00
abstract:BACKGROUND:Apnea testing is an essential step in the clinical diagnosis of brain death. Current international guidelines recommend placement of an oxygen (O2) insufflation catheter into the endotracheal tube to prevent hypoxemia, but use of a continuous positive airway pressure (CPAP) valve may be more effective at lim...
journal_title:Neurocritical care
pub_type: 杂志文章,多中心研究
doi:10.1007/s12028-017-0380-0
更新日期:2017-08-01 00:00:00